Key result
Patent false lumen in ATAAD is linked to ~10-fold higher long-term mortality versus thrombosed lumen.
Why the study?
False lumen patency in acute type A aortic dissection is associated with adverse outcomes, but the role of coagulation defects in predicting false lumen fate is unclear.
Does a patent false lumen compared to a thrombosed false lumen reduce long-term survival in patients with acute type A aortic dissection?
Case-Control (n=123)
No
Does a patent false lumen compared to a thrombosed false lumen reduce long-term survival in patients with acute type A aortic dissection?
In patients with acute type A aortic dissection, a patent false lumen is associated with significantly reduced long-term survival and is predicted by intrinsic pathway coagulation abnormalities.
Answers are grounded in this paper and cite their sources.
May support coagulation profiling for FL risk stratification in TAAD; leaves open confirmation in prospective cohorts.
BACKGROUND & AIM: Acute type A aortic dissection (TAAD) is associated with high mortality and morbidity. False lumen (FL) patency is associated with malperfusion, aortic expansion, reoperation and reduced survival. Our aim was to determine if coagulation defects predict the fate of the FL. METHODS: We conducted a single-centre, retrospective, case-controlled study of patients with TAAD. Patient demographics, preoperative characteristics, operative details, postoperative complications, and follow-up computed tomography scans at 1 year were compared between patients who presented with patent FL and thrombosed FL. Coagulopathy was evaluated using standard laboratory tests and thromboelastography on admission, postoperatively, and at discharge. The primary outcome was long-term survival. RESULTS: Of 123 eligible patients with TAAD, 67% (n=79) had patent FL and 33% (n=38) had thrombosed FL. Patent FL was associated with higher in-hospital (38.0 % vs 5.3% p<0.05) and mid-term mortality (93.0% vs 7.0%, p<0.05), postoperative dialysis (5.1% vs 0, p=0.04) and gastrointestinal ischaemia (17.7% vs 5.3%, p<0.05) compared to the thrombosed FL group. Survival analysis included a maximum follow-up of 8.61 years and demonstrated reduced survival in patients with a patent FL (hazard ratio [HR] 10.2, 95% confidence interval [CI] 3.00-34.6, p<0.001). Multivariable logistic regression analysis identified preoperative activated partial thromboplastin time (APTT), postoperative day 1 APTT, R value and alpha angle as independent predictors of patent FL. CONCLUSIONS: Patients with a patent FL have a higher risk of mid- and long-term mortality and postoperative morbidity. Abnormalities in coagulation tests, particularly of the intrinsic pathway, are associated with FL patency. The coagulation cascade represents a novel therapeutic target to promote FL thrombosis.
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Thanalingam et al. (2026) conducted a case-control in Acute type A aortic dissection (TAAD) (n=123). Patent false lumen vs. Thrombosed false lumen was evaluated on long-term survival (HR 10.2, 95% CI 3.00-34.6, p=<0.001). A patent false lumen in acute type A aortic dissection was associated with reduced long-term survival compared to a thrombosed false lumen.
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